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World J Gastroenterol. Jul 14, 2023; 29(26): 4174-4185
Published online Jul 14, 2023. doi: 10.3748/wjg.v29.i26.4174
Progress in immunotherapy for neuroendocrine neoplasm of the digestive system
Wei-Xuan Pan, Xin-Mu Zhang, Shao-Long Hao, Wei Han
Wei-Xuan Pan, Shao-Long Hao, Wei Han, Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China
Xin-Mu Zhang, Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Pan WX and Zhang XM contributed equally to this work; Pan WX, Zhang XM, Hao SL, and Han W contributed to writing-review & editing; Pan WX contributed to writing-original draft, Visualization; Zhang XM and Han W contributed to supervision Zhang XM contributed to conceptualization, investigation; Han W contributed to project administration.
Supported by Capital Health Development Research Program, No. 2022-2-7081; Science and Technology Program of Tongzhou, Beijing, No. KJ2022CX016; Beijing Natural Science Foundation, No. 7234377.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Han, MD, Chief Doctor, Director, Professor, Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, No. 28 South Xinhua Road, Tongzhou District, Beijing 101100, China. dr-han1972@mail.ccmu.edu.cn
Received: May 4, 2023
Peer-review started: May 4, 2023
First decision: May 19, 2023
Revised: May 29, 2023
Accepted: June 13, 2023
Article in press: June 13, 2023
Published online: July 14, 2023
Abstract

Neuroendocrine neoplasms (NENs) are rare heterogeneous tumors that can develop in almost any organ, with the digestive organs, including the gastrointestinal tract and pancreas being the most commonly affected sites. Despite the fact that advances in initial therapies have progressed, there is presently no recognized effective treatment for advanced NEN. Immune checkpoint inhibitors (ICIs) have shown superior efficacy in treating several types of solid tumors. Despite their successful role in the treatment of partial NENs, such as small cell lung cancer, and Merkel cell carcinoma, the role of ICIs in most of the NENs remains limited. Nevertheless, due to their specific anti-tumor mechanisms and acceptable safety profile, ICIs are a promising avenue for further study in NENs therapy. Recent clinical trials have illustrated that combination therapy with ICI is more efficient than monotherapy, and multiple clinical trials are constantly ongoing to evaluate the efficacy and safety of these combination therapies. Therefore, the purpose of this review is to provide a comprehensive summary of the clinical progress of immunotherapy in NENs affecting the digestive system, with a specific emphasis on the application of programmed cell death protein 1/programmed death receptor ligand 1 inhibitor. Furthermore, this review has an exploration of the potential beneficiary population and the inherent value of utilizing immunotherapy in the management of NENs.

Keywords: Immunotherapy, PD-1 inhibitor, Neuroendocrine neoplasm, Neuroendocrine tumor, Neuroendocrine carcinoma, Gastrointestinal, Pancreatic

Core Tip: The application of immune checkpoint inhibitor (ICI) in neuroendocrine neoplasm (NEN) is regulated by the latest clinical practice guidelines. However, immunotherapy has achieved some breakthroughs for high-grade or advanced NENs of the digestive system, for which there is currently no effective drug therapy. In this regard, we investigated the causes of the heterogeneous efficacy of ICI in NEN with different grades, differentiation, and primary organs. This review summarizes the state-of-the-art progress and trend of clinical trials for different ICI-containing regimens in NENs of the digestive system, which will aid in the conduct of subsequent clinical trials and research of related mechanisms.